Ea. Balas et al., EFFECT OF PHYSICIAN PROFILING ON UTILIZATION - METAANALYSIS OF RANDOMIZED CLINICAL-TRIALS, Journal of general internal medicine, 11(10), 1996, pp. 584-590
OBJECTIVES: An American medical Association survey reported that more
than half of physicians are subjects of either clinical or economic pr
ofiling. This multilevel meta-analysis was designed to assess the clin
ical effect of peer-comparison feedback intervention (profiles) in cha
nging practice patterns. METHODS: Systematic computerized and manual s
earches were combined to retrieve articles on randomized controlled cl
inical trials testing profiling reports. Eligible studies were randomi
zed, controlled clinical trials that tested peer-comparison feedback i
ntervention and measured utilization of clinical procedures. To use al
l available information, data were abstracted and analyzed on three le
vels: (1) direction of effects, (2) p value ham the statistical compar
ison, and (3) odds ratio (OR). MAIN RESULTS: In the 12 eligible trials
, 553 physicians were profiled. The test result was p < .05 for the vo
te-counting sign test of 12 studies (level 1) and p < .05 far the z-tr
ansformation test of 8 studies (level 2). There were 5 trials included
In the OR analysis (level 3). The primary effect variable in two Of t
he 5 trials had a nonsignificant OR. However, the overall OR calculate
d by the Mantel-Haenszel method was significant (1.091, confidence int
erval: 1.045 to 1.136). CONCLUSIONS: Profiling has a statistically sig
nificant, hut minimal effect on the utilization of clinical procedures
. The results of this study indicate a need for controlled clinical ev
aluations before subjecting large numbers of physicians to utilization
management interventions.